Acid blockers increase risk of COVID-19 and other illnesses

Acid-reducing drugs, also known as proton pump inhibitors (PPIs), are one of the most successful drug classes ever launched, and are expected to bring in up to $3.26 billion in profits in 2026.

“Twenty-five years after their introduction into clinical practice, PPIs remain the mainstay of treatment for acid-related diseases,” says a study published in the journal BMC Medical. “Overall, PPIs are irreplaceable drugs in the management of acid-related diseases.”

Comprising both prescription and over-the-counter preparations, PPIs are intended to treat acidic conditions such as gastroesophageal reflux or GERD (which arises from stomach acid repeatedly flowing back up the esophagus) as well as other conditions such as heartburn, stomach discomfort, and the risk of gastrointestinal bleeding in ulcer patients or those using blood thinners, such as aspirin. More than 15 million Americans have been prescribed PPI prescriptions and many more are buying the drugs over-the-counter.

But despite their popularity, questions remain about the drug class. According to a 2018 study published in the Journal of Neurogastroenterology and Motility, “PPIs tend to be given for conditions in which the need for the drug has not been clarified”, opening the door to adverse effects, although rare. , such as :

  • Allergic reactions
  • Collagenous colitis
  • Kidney damage
  • Liver damage/abdominal fluid infection
  • Dementia
  • Pneumonia
  • Gastrointestinal infection
  • Gastric tumors
  • Gastric inflammation/ulcers
  • Gastric polyps
  • Colon cancers
  • Intestinal bacterial overgrowth
  • Hypomagnesemia
  • Decreased nutrient absorption

The dementia risk of PPIs drew attention in 2016 when an observational study by German researchers was published in JAMA Neurology. It linked regular use of PPIs to a 44% increased risk of dementia compared to people not using the drugs.

The study was based on the medical records of 73,679 people aged 75 and over.

Research published in the journal Expert Review of Clinical Pharmacology elaborates and adds to the possible risks of PPI:

“The risk of pneumonia [from PPI use] increased by 27-39% in short-term use of PPIs in three meta-analyses,” the researchers wrote. “C. difficult infections [a serious intestinal parasite] were also associated with PPI use,” as were thrombocytopenia (low blood platelet count), rhabdomyolysis (muscle damage and breakdown) and nephritis (inflammation of the kidneys).

Research published in Current Gastroenterology Reports echoes the danger of vitamin and mineral deficiencies cited in the Journal of Neurogastroenterology and Motility.

The US Food and Drug Administration (FDA) is aware of the risks, which increase with long-term use. According to an American pharmacist, “Since 2010, the FDA has issued various safety warnings regarding the potential effects of long-term use of PPIs”, not only the adverse events listed by the Journal of Neurogastroenterology and Motility, but also the risks PPI-related fractures, Clostridium difficile-associated diarrhea, and lupus-related events.

“Although proton pump inhibitors (PPIs) remain the primary treatment for GERD, they do not cure the disorder and may leave patients with persistent symptoms despite treatment,” Physician’s Weekly adds. Patients are also not immune to other conditions, the publication states, noting that “patients are still at risk of developing complications such as peptic strictures, Barrett’s metaplasia and esophageal cancer.”

Since the class of drugs is intended to be used for the shortest possible duration, the journal Gastroenterology warns that “patients with uncomplicated GERD who respond to short-term PPIs should subsequently attempt to stop or reduce them.” Patients who cannot reduce PPIs should consider ambulatory esophageal pH/impedance monitoring [measuring the amount of acidic and non-acidic reflux in the esophagus during a 24-hour period] before committing to lifelong PPIs to help distinguish GERD from a functional syndrome.

A class of drugs with strengths and weaknesses

Certainly, acid-related conditions, like when excess acid appears in the wrong place, do happen and are uncomfortable. Such occurrences are “threatening, inflaming and irritating the esophagus, usually causing heartburn and sometimes contributing to the development of ulcers in the stomach and duodenum, the first part of the small intestine”, explains Harvard Health.

And yet, the potential long-term side effects revealed by researchers and health agencies raise the question of whether the drugs are over-prescribed.

“Taking a PPI makes sense if you have a chronic stomach acid problem or the prospect of development,” says Harvard Health. “But the occasional case of mild heartburn doesn’t need to be treated with a PPI. For that sort of spot job, older antacid remedies like Tums, Rolaids and Maalox will most likely work just as well.

Cedars-Sinai, a nonprofit academic health care organization, points out that taking an acid blocker does not address other causes of GERD such as “overweight, overeating, caffeine, and ‘alcohol, and the consumption of chocolate and spicy foods’.

And there is another potential adverse effect with PPIs according to the American pharmacist: hypergastrinemia.

“This condition causes rebound hyperacidity; after discontinuation of PPI therapy, patients may experience worsening of GERD symptoms,” the publication states. “To avoid this, PPIs must be gradually reduced. Additionally, hypergastrinemia can cause hypertrophy of parietal cells and enterochromaffin-like cells (ECL) [gastric secreting cells] undergo hyperplasia.

PPIs related to COVID-19 contracting

Because our stomach acid protects us from a lot of viruses and bacteria, some people, especially those in the medical field, weren’t too surprised when PPIs were linked to a greater risk of contracting COVID-19 in the start of the pandemic.

In 2020, the American Journal of Gastroenterology published a study by researchers affiliated with Cedars-Sinai Medical Center and Michigan Medicine that discussed the link.

“In a nationwide study of people with a history of gastrointestinal symptoms, we found that PPI use is associated with an increased likelihood of reporting a positive COVID-19 test. The highest risk is seen in people taking twice-daily PPIs – a common off-label practice in primary and secondary care – as they are almost 4 times more likely to report COVID-19 positivity compared to those not taking PPIs.

Dr. Brennan Spiegel, one of the researchers and guarantor of the study (a research author responsible for the integrity of the work as a whole) told Time: “Viruses like SARS-CoV-2 are able quickly divert the gastrointestinal tract. … It can invade, replicate and multiply effectively. There is even a theory that it may be using the intestines as a sort of home base where it takes root and then spreads throughout the body.

The following year, the journal Gut reported on related research. In a cohort of over 100,000 PPI users, nonusers, and former users, PPIs were not linked to a higher risk of catching COVID-19, but PPI users experienced “a 79% higher risk of serious clinical outcomes from COVID-19.” 19,” the newspaper said. While the potential risks of PPIs were identified long before COVID-19, the pandemic has clearly added to the questions.

Alternatives to PPIs

Are there any herbs that can help reduce stomach acid? Yes, according to a 2019 study published in the journal Current Gastroenterology Reports.

“With a focus on reflux and non-cardiac chest pain, research is ongoing into the clinical utility and various physiological mechanisms underlying a variety of complementary and alternative modalities,” wrote researchers associated with Thomas Jefferson University and the University of Pennsylvania.

Complementary and alternative modalities include “food manipulation, apple cider vinegar, melatonin, acupuncture, and various herbal products (rikkunshito, STW 5, slippery elm, licorice, and peppermint oil, among others) “. While the researchers acknowledge a “substantial gap” between “anecdotal and empirical” knowledge of non-pharmacological remedies for acidic diseases, this also calls for “compelling” future research opportunities.

Finally, Johns Hopkins Medicine reminds people to avoid certain foods associated with an acid reaction such as:

  • Frying
  • fast food
  • Pizza
  • Potato chips and other processed snacks
  • Chilli powder and pepper (white, black, cayenne)
  • Fatty meats like bacon and sausages
  • Cheese
  • Tomato-based sauces
  • citrus fruits
  • Chocolate
  • Pepper mint
  • Fizzy drinks

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Martha Rosenberg is a nationally recognized journalist and author whose work has been cited by Mayo Clinic Proceedings, the Public Library of Science Biology, and National Geographic. Rosenberg’s FDA exhibit, “Born With Junk Food Deficiency,” established her as a top investigative journalist. She has lectured extensively at universities across the United States and resides in Chicago.

Acid blockers increase risk of COVID-19 and other illnesses

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